Perioperative myocardial ischemia (PMI) in patients undergoing coronary artery bypass grafting (CABG) is associated with poor outcome. The aim of this study was to pool the available data on the outcome after control angiography and repeat revascularization in patients with perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG). A literature review was performed through PubMed, Scopus, ScienceDirect and Google Scholar to identify studies published since 1990 evaluating the outcome of PMI after CABG. Nine studies included 1104 patients with PMI after CABG and 1056 of them underwent control angiography early after CABG. Pooled early mortality after reoperation for PMI without control angiography was 43.6% (95%CI 29.7-57.6%) and 79.8% of them (95%CI 64.4-95.2%) had an acute graft failure detected at reoperation. Among patients who underwent control angiography for PMI, 31.7% had a negative finding at angiography (95%CI 25.6-37.8%) and 62.1% had an acute graft failure (95%CI 56.6-67.6%). Repeat revascularization was performed after early control angiography in 46.3% of patients (95%CI 39.9-52.6%; 54.2% underwent repeat surgical revascularization; 45.8% underwent percutaneous coronary intervention). Pooled early mortality after control angiography with or without repeat revascularization was 8.9% (95%CI 6.7-11.1%). Three studies reported on early mortality rates which did not differ between repeat surgical revascularization and PCI (11.7% vs. 9.2%, respectively; risk ratio 1.45, 95%CI 0.67-3.11). In these three series, early mortality after conservative treatment was 5.9% (95%CI 3.6-8.2%). Control angiography seems to be a valid life-saving strategy to guide repeat revascularization in hemodynamically stable patients suffering PMI after CABG.

/pdf/control-angiography-for-perioperative-myocardial-ischemia-3rlta0pw2w.pdf

Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis

Postcardiac surgery myocardial ischemia: Why, when, and how to intervene

INTRODUCTION: To date, highly effective methods of myocardial protection have been developed, which are widely used in cardiac surgery. At the same time, the problem of perioperative myocardial infarction still exists and is one of the causes of adverse cardiovascular events and mortality, both at the hospital stage of treatment and in the long-term period. A factor leading to such a complication may be acute dysfunction of the coronary bypass graft, the timely detection and elimination of which will reduce the negative consequences of myocardial damage. The relevance of the study results from investigation of the relationship between the angiographic data and the character of ischemic changes on the electrocardiogram of patients with and without proven acute dysfunction of coronary bypass graft. AIM: Identification of the most pathognomonic electrocardiographic signs of dysfunction of coronary bypass grafts in the early postoperative period after planned myocardial revascularization. MATERIALS AND METHODS: The study included 196 (1.86%) of 10,550 patients operated for coronary artery disease in Chelyabinsk Center of Cardiovascular Surgery from 2011 to 2020, who underwent emergency angiography after planned coronary artery bypass graft surgery due to the appearance of signs of myocardial damage in the early postoperative period. Depending on the type of angiographic findings and the chosen treatment tactics, patients were divided to 3 groups. Group I (n = 86) included patients in whom angiography revealed defects in the area of large bypassed coronary arteries, of them 60 patients underwent endovascular treatment, and 26 patients underwent repeated open surgery. Group II (n = 33) consisted of patients in whom bypass graft dysfunction was noted, but, however, due to the small diameter or pronounced diffuse lesion of the bypassed coronary arteries, all the patients underwent conservative therapy. Group III included 77 patients in whom hemodynamically significant defects in grafts and native arteries were not identified. RESULTS: When studying postoperative electrocardiographic data, it was found that significant differences between the groups were obtained only in the occurrence of ventricular arrhythmias (P1–2 = 0.027; P2–3 = 0.01). As for other pathological electrocardiographic signs and their combinations, no statistical differences were found. CONCLUSIONS: An isolated electrocardiographic study in the early postoperative period does not permit to identify patients with dysfunction of coronary bypass grafts. It is necessary to develop a diagnostic algorithm, including instrumental and laboratory methods, for accurate diagnosis of myocardial ischemia caused by impaired graft function or pathological deformation of the coronary bed due to surgical procedures.

/pdf/electrocardiographic-changes-in-early-period-after-planned-dgoqwhsz.pdf

Electrocardiographic Changes in Early Period after Planned Myocardial Revascularization

Introduction: Incorrect performance of anastomoses to the target coronary arteries often causes coronary artery disease and patient`s death following myocardial revascularization. Coronary graft patency evaluation is obligatory for prevention of peri- and postoperative myocardial ischemia. Aim: The objective of the present study was to comparatively assess the values of mean coronary flow and pulsatility index in arterial and venous grafts in patients after on-pump- and off-pump myocardial revascularization. Materials and Methods: During the period between January 1, 2014 and December 31, 2017, 143 coronary artery disease patients, 111 males at a mean age of 63.29±9.78 years and 32 females at a mean age of 66.43±9.58 years were operated on in the Department of Cardiac Surgery, St. Marina University Hospital of Varna. Myocardial revascularization was performed by using 92 arterial and 65 venous coronary grafts in the on-pump group (ONCAB) and 137 arterial and 45 venous grafts in the off-pump group (OPCAB). Coronary graft blood flow was assessed by means of coronary angiography and transit-time flowmetry (TTFM). Results: There were different values of the mean coronary flow and pulsatility index (PI) in arterial and venous conduits, both intervention types, as well as in males and females. The difference between male and female patients in terms of the mean values of venous grafts is statistically reliable (I‡ 2 =11.410; N€â‰¤0.022 and r=-0.310; p=0.001). The PI values in arterial grafts differed statistically significantly between both intervention types (p=0.003). Much more revisions of arterial and venous conduits on the occasion of insufficient patency were performed in the ONCAP than in the OPCAB group. Conclusion : Based on our results and literature data available, we could recommend the wide application of the method of TTFM for exact recognition of the circulatory disorders in the coronary graft following CAGB in Bulgaria.

https://journals.mu-varna.bg/index.php/ssm/article/download/5443/4924

Transit-time flowmetric evaluation of coronary artery bypass graft flow after off- and on-pump myocardial revascularization

From the Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga. Disclosures: Dr Halkos is an advisory board member for Medtronic, Inc, and has a patent for a new minimally invasive coronary stabilizer. Dr Winters reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. Received for publication March 16, 2020; revisions received March 16, 2020; accepted for publication April 2, 2020; available ahead of print April 11, 2020. Address for reprints: Amalia A. Winters, MD, 1365 Clifton Rd NE, Building A, Suite A2202, Atlanta, GA 30322 (E-mail: amalia.winters@emory.edu). JTCVS Techniques 2020;3:190-3 2666-2507 Copyright 2020 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/). https://doi.org/10.1016/j.xjtc.2020.04.007 Preoperative (left), completion (middle), and 12month follow-up (right) angiograms.

To intervene or not to intervene: Lessons learned from completion angiography after robotic-assisted coronary bypass surgery.

Objectives Coronary angiography is the golden standard when myocardial ischemia after CABG occurs. We summarize our experience of acute coronary angiography after CABG. Design All 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG 2007 to 2012 were included in this retrospective observational study. Incidence, indications, findings, measures of acute angiography after CABG was assessed. Outcome variables were compared between patients who underwent angiography and those who did not. Results Eighty-seven patients (2%) underwent acute coronary angiography. Patients undergoing angiography had ECG changes (92%), echocardiographic alterations (48%), hemodynamic instability (28%), angina (15%), and/or arrhythmia (13%). Positive findings were detected in 69% of the cases. Only ECG changes as indication for angiography had a moderate association with positive findings, but the precision increased if other sign(s) of ischemia were present. Thirty-day mortality (7% versus 2%, p = 0.002) was...

Acute coronary angiography after coronary artery bypass grafting.

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Acute coronary angiography after coronary artery bypass grafting.